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Test ID CRU Chromium, 24 Hour, Urine

Reporting Name

Chromium, 24 Hr, U

Useful For

Screening for occupational exposure to chromium

 

Monitoring metallic prosthetic implant wear

Specimen Type

Urine


Ordering Guidance


High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.



Specimen Required


Supplies: Urine Tubes, 10 mL (T068)

Collection Container/Tube: Clean, plastic urine container with no metal cap or glued insert

Submission Container/Tube: Plastic, 10-mL urine tube or clean, plastic aliquot container with no metal cap or glued insert

Specimen Volume: 10 mL

Collection Instructions:

1. Collect urine for 24 hours.

2. Refrigerate specimen within 4 hours of completion of 24-hour collection.

3. See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.

Additional Information:

1. 24-Hour volume is required.

2. See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens in Special Instructions for multiple collections.


Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Reference Values

0-17 years: not established

≥18 years: 0.1-1.2 mcg/24 hours

Day(s) Performed

Tuesday, Wednesday, Friday

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

82495

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CRU Chromium, 24 Hr, U 5624-2

 

Result ID Test Result Name Result LOINC Value
8593 Chromium, 24 Hr, U 5624-2
TM44 Collection Duration 13362-9
VL42 Urine Volume 3167-4

Clinical Information

Chromium (Cr) exists in valence states ranging from 2(-) to 6(+). Hexavalent chromium (Cr[6+]) and trivalent chromium (Cr[3+]) are the 2 most prevalent forms. Cr(6+) is used in industry to make chromium alloys including stainless steel, pigments, and electroplated coatings. Cr(6+), a known carcinogen, is immediately converted to Cr(3+) upon exposure to biological tissues. Cr(3+) is the only chromium species found in biological specimens.

 

Urine chromium concentrations are likely to be increased above the reference range in patients with metallic joint prosthesis. Prosthetic devices produced by Depuy Company, Dow Corning, Howmedica, LCS, PCA, Osteonics, Richards Company, Tricon, and Whiteside typically are made of chromium, cobalt, and molybdenum. This list of products is incomplete, and these products change occasionally; see prosthesis product information for each device for composition details.

Interpretation

Chromium is principally excreted in the urine. Urine levels correlate with exposure. Results greater than the reference range indicate either recent exposure to chromium or specimen contamination during collection.

 

Prosthesis wear is known to result in increased circulating concentration of metal ions. Modest increase (8-16 mcg/24 hour) in urine chromium concentration is likely to be associated with a prosthetic device in good condition. Urine concentrations greater than 20 mcg/24 hours in a patient with chromium-based implant suggest significant prosthesis wear. Increased urine trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.

 

The National Institute for Occupational Safety and Health (NIOSH) draft document on occupational exposure reviews the data supporting use of urine to assess chromium exposure. They recommend a Biological Exposure Index of 10 mcg/g creatinine and 30 mcg/g creatinine for the increase in urinary chromium concentrations during a work shift and at the end of shift at the end of the workweek, respectively. A test for this specific purpose (CROMU / Chromium for Occupational Monitoring, Random, Urine) is available.

Clinical Reference

1. Vincent JB: Elucidating a biological role for chromium at a molecular level. Acc Chem Res. 2000 July;33(7):503-510

2. The National Institute for Occupational Safety and Health (NIOSH): NIOSH Criteria Document: Criteria for a Recommendation Standard for an Occupational Exposure to Hexavalent Chromium. September 2013 Available at www.cdc.gov/niosh/docs/2013-128/pdfs/2013_128.pdf

3. Keegan GM, Learmonth ID, Case CP: A systematic comparison of the actual, potential, and theoretical health effects of cobalt and chromium exposures from industry and surgical implants. Crit Rev Toxicol. 2008;38:645-674

Report Available

1 to 4 days

Method Name

Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS)

Urine Preservative Collection Options

Note: The addition of preservative or application of temperature controls must occur within 4 hours of completion of the collection.

Ambient

OK

Refrigerate

Preferred

Frozen

OK

50% Acetic Acid

No

Boric Acid

No

Diazolidinyl Urea

No

6M Hydrochloric Acid

No

6M Nitric Acid

No

Sodium Carbonate

No

Thymol

No

Toluene

No